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JBRA Assisted Reproduction Jun 2024This study examined whether blastocysts transferred on day 5 or day 6 of embryo development, as well as positivity for anti-thyroid peroxidase antibodies, affect...
OBJECTIVE
This study examined whether blastocysts transferred on day 5 or day 6 of embryo development, as well as positivity for anti-thyroid peroxidase antibodies, affect gestational outcomes in euthyroid women undergoing in vitro fertilisation.
METHODS
Of 428 women who underwent in vitro fertilisation assessed in this retrospective cohort study, 212 (49.5%) underwent embryo transfer on day 5 of blastulation and 216 (50.5%) on day 6. Dichotomization based on anti-thyroid peroxidase antibodies status was also performed, with 370 (86.4%) women testing negative and 58 (13.6%) testing positive. Clinical and hormonal data and rates of clinical pregnancy, miscarriage, and live births were compared between the groups.
RESULTS
When evaluating gestational outcomes based on the day of blastulation, a statistically significant difference was observed in clinical pregnancy rates [51.4% (day 5) vs. 40.7% (day 6); p=0.033]. However, there was no significant difference in the relative frequencies of miscarriages (p=1.000), live births (p=1.000), or preterm births (p=1.000). Using Cramer's V test, a weak association was found between the day of blastulation and clinical pregnancy outcomes (V2=10.7%; p=0.027). There were no statistically significant differences between the anti-thyroid peroxidase antibodies-negative and -positive groups in terms of clinical pregnancy rates (p=0.396), miscarriages (p=0.129), and live births (p=0.129).
CONCLUSIONS
Higher rates of clinical pregnancy were observed in women who underwent embryo transfers performed on day 5 compared to those on day 6. However, no effect was observed with gestational outcomes. Further, anti-thyroid peroxidase antibody positivity did not have a statistically significant impact on gestational outcomes.
PubMed: 38848251
DOI: 10.5935/1518-0557.20240036 -
Medicine Jun 2024The current research aims to investigate the relationship between Interleukin-17 (IL-17) polymorphism and the risk of recurrent pregnancy loss (RPL) within a Chinese...
The current research aims to investigate the relationship between Interleukin-17 (IL-17) polymorphism and the risk of recurrent pregnancy loss (RPL) within a Chinese population. Totally, 120 patients with RPL were selected and enrolled as the experiment group. Additionally, 210 healthy individuals undergoing routine physical examinations during the same period served as the control group. The IL-17 gene polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism method. The IL-17 rs2275913 polymorphism exhibited 3 genotypes: GG, GA, and AA. Significant associations were observed with the AA genotype and A allele (all P < .05), indicating women with the AA genotype were 2.06 times more likely to experience RPL compared to those with the GG genotype. Similarly, women carrying the A allele faced a 1.63 times higher risk of RPL than those with the G allele. Regarding the IL-17 rs763780 polymorphism, which also presented 3 genotypes (TT, TC, CC), significant associations were noted for the CC genotype and C allele (all P < .05). Women with the CC genotype had a 1.84 times greater risk of suffering from RPL compared to those with the TT genotype, and those with the C allele were 1.51 times more likely to experience RPL than those with the T allele. The IL-17 rs2275913 and rs763780 polymorphisms contribute an increased risk to RPL in the Chinese population. Further studies, with larger sample sizes and more rigorous designs, are necessary to validate or replicate our current results.
Topics: Humans; Female; Abortion, Habitual; Interleukin-17; Adult; Genetic Predisposition to Disease; Pregnancy; China; Asian People; Polymorphism, Single Nucleotide; Case-Control Studies; Genotype; Alleles; East Asian People
PubMed: 38847697
DOI: 10.1097/MD.0000000000038333 -
Research and Practice in Thrombosis and... May 2024Paroxysmal nocturnal hemoglobinuria (PNH), a rare hematologic disease, is associated with high maternal and fetal mortality rates. Only 1 medication approved for PNH,...
BACKGROUND
Paroxysmal nocturnal hemoglobinuria (PNH), a rare hematologic disease, is associated with high maternal and fetal mortality rates. Only 1 medication approved for PNH, the complement component 5 inhibitor eculizumab, has published evidence of use during pregnancy.
KEY CLINICAL QUESTION
What were the circumstances and outcomes of the first use of pegcetacoplan, a complement component 3 inhibitor, by a pregnant woman with PNH?
CLINICAL APPROACH
The patient, with a history of 2 miscarriages and a suboptimal response to eculizumab, had hematologic improvement after switching to pegcetacoplan. She continued pegcetacoplan throughout her pregnancy. At gestational week 30, she developed abruptio placentae and breakthrough hemolysis. She delivered a normal-appearing male infant via emergency cesarean section. The breakthrough hemolysis resolved quickly with short-term intensive pegcetacoplan dosing and add-on eculizumab. To date, her laboratory values remain normal, and she has had no thromboembolic events; her son has not demonstrated growth defects.
CONCLUSION
This is the first report of pegcetacoplan treatment for PNH throughout pregnancy. The mother recovered promptly from breakthrough hemolysis that prompted an emergency delivery. Her son, who was born prematurely but healthy, has developed normally.
PubMed: 38846741
DOI: 10.1016/j.rpth.2024.102435 -
BMC Medical Genomics Jun 2024Recurrent pregnancy loss (RPL) is a common pregnancy complication that brings great pain to pregnant women and their families. Genetic factors are an important cause...
BACKGROUND
Recurrent pregnancy loss (RPL) is a common pregnancy complication that brings great pain to pregnant women and their families. Genetic factors are an important cause reason of RPL. However, clinical research on monogenic diseases with recurrent miscarriage is insufficient.
CASE PRESENTATION
Here we reported a Chinese family with RPL and genetic analysis of the abortion and parents. A paternally inherited heterozygous missense variant c.1415T > G (p.V472G) and a maternally inherited heterozygous nonsense variant c.2314del (p.M772*) in TMEM67 gene were identified by trio-exome sequencing. c.2314del (p.M772*) generated a premature stop codon and truncated protein, was classified as "pathogenic". c.1415T > G (p.V472G) located in extra-cellular region, was classified as "likely pathogenic". Biallelic variants in TMEM67 gene cause lethal Meckel syndrome 3, consistent with the proband's prenatal phenotype.
CONCLUSION
The current study of the Chinese family expands the pathogenic variant spectrum of TMEM67 and emphasizes the necessity of exome sequencing in RPL condition.
Topics: Humans; Female; Membrane Proteins; Abortion, Habitual; Pregnancy; Pedigree; Adult; Asian People; Male; Exome Sequencing; China; East Asian People
PubMed: 38844949
DOI: 10.1186/s12920-024-01902-x -
Alternative Therapies in Health and... Jun 2024To investigate the clinical effect of aspirin (ASA) combined with low molecular weight heparin (LMWH) in the treatment of recurrent spontaneous abortion (RSA).
OBJECTIVE
To investigate the clinical effect of aspirin (ASA) combined with low molecular weight heparin (LMWH) in the treatment of recurrent spontaneous abortion (RSA).
METHODS
PubMed, Cochrane, Wanfang, CNKI, and other databases were searched to collect randomized controlled trials (RCT) of aspirin combined with LMWH in the treatment of RSA from the establishment of the database to July 31, 2023. The literature was screened, and the information was extracted according to the pre-established criteria. The Reviews Manager 5.4 software was used for data analysis.
RESULTS
A total of 10 RCTs containing 1865 patients with RSA were included in this study. Meta-analysis showed that the regimen of aspirin combined with LMWH treatment significantly increased the neonatal birth rate (P < .01); and the occurrence of preeclampsia was significantly reduced when compared with regimens such as aspirin alone (P = .02); there were no significant differences between the two groups in the incidence of preterm birth (P = .21), neonatal birth weight (P = .38), the incidence of a small amount of patient hemorrhage (P = .41) and fetal growth restriction (P = .93).
CONCLUSION
The combination of aspirin and LMWH offers a clinically significant improvement in live birth rates and reduction in preeclampsia for RSA patients, suggesting a beneficial strategy for clinical practice and future research directions.
PubMed: 38843415
DOI: No ID Found -
Clinical Case Reports Jun 2024In this case report, we describe the successful management of severe scrub typhus with pneumonia, sepsis, and multiple organ dysfunction in a pregnant woman. Despite...
KEY CLINICAL MESSAGE
In this case report, we describe the successful management of severe scrub typhus with pneumonia, sepsis, and multiple organ dysfunction in a pregnant woman. Despite initial challenges, the patient responded favorably to fecal microbiota transplantation and oral fecal microbiota capsule therapy.
ABSTRACT
Scrub typhus, caused by , can lead to severe multiorgan dysfunction and carries a mortality rate of up to 70% if not treated properly. In this report, we present the case of a 27-year-old pregnant woman at 18 + 6 weeks gestation whose symptoms worsened 15 days after onset and progressed to severe pneumonia with sepsis and multiple organ dysfunction syndrome. After the pathogen was confirmed by next-generation sequencing analysis of bronchoalveolar-lavage fluid and blood samples, the patient's treatment was switched to antiinfective chloramphenicol. The patient also underwent uterine evacuation due to a miscarriage. Extracorporeal membrane oxygenation was discontinued once the pulmonary infection significantly improved. Subsequently, the patient had recurrent diarrhea, abdominal distension, and difficulty eating. The antibiotic regimen was adjusted according to the drug sensitivity, but the diarrhea and abdominal distension still did not improve. Following a comprehensive multidisciplinary risk assessment, we initiated fecal microbiota transplantation and oral fecal microbiota capsule therapy. As a result, the patient's condition was effectively managed, and they were gradually discharged. Fecal microbiota transplantation may be a safe and effective treatment for severe pneumonia and shock in pregnant women. This has significant implications for maternal health. However, further clinical cases are required to observe its long-term effectiveness.
PubMed: 38840756
DOI: 10.1002/ccr3.8815 -
Fertility and Sterility Jun 2024To determine whether obstetric outcomes differ between women with endometriosis and those without, where all women undergo first-trimester screening for endometriosis.
OBJECTIVE
To determine whether obstetric outcomes differ between women with endometriosis and those without, where all women undergo first-trimester screening for endometriosis.
DESIGN
A prospective observational cohort study.
SETTING
The Early Pregnancy Unit at University College London Hospital, United Kingdom.
PATIENTS
Women with a live pregnancy progressing beyond 12 weeks' gestation and concurrent endometriosis (n = 110) or no endometriosis (n = 393).
INTERVENTION
All women underwent a pelvic ultrasound examination in early pregnancy to examine for the presence of endometriosis and uterine abnormalities.
MAIN OUTCOME MEASURES
The primary outcome of interest was preterm birth, defined as delivery before 37 completed weeks' gestation. Secondary outcomes included late miscarriage, antepartum hemorrhage, placental site disorders, gestational diabetes, hypertensive disorders of pregnancy, neonates small for gestational age, mode of delivery, intrapartum sepsis, postpartum hemorrhage, and admission to the neonatal unit.
RESULTS
Women with a diagnosis of endometriosis did not have statistically significantly higher odds of preterm delivery (adjusted odds ratio [aOR] 1.85 [95% confidence interval {CI} 0.50-6.90]), but they did have higher odds of postpartum hemorrhage during cesarean section (aOR 3.64 [95% CI 2.07-6.35]) and admission of their newborn infant to the neonatal unit (aOR 3.24 [95% CI 1.08-9.73]). Women with persistent or recurrent deep endometriosis after surgery also had higher odds of placental site disorders (aOR 8.65 [95% CI 1.17-63.71]) and intrapartum sepsis (aOR 3.47 [95% CI 1.02-11.75]).
CONCLUSION
We observed that women with endometriosis do not have higher odds of preterm delivery, irrespective of their disease subtype. However, they do have higher odds of postpartum hemorrhage during the cesarean section and newborn admission to the neonatal unit.
PubMed: 38838806
DOI: 10.1016/j.fertnstert.2024.05.162 -
The Application of Clinical Genetics 2024The potential causes of miscarriage are very complex, including genetic, immune, infectious, and endocrine factors. 50%-60% of miscarriages are caused by chromosomal...
BACKGROUND
The potential causes of miscarriage are very complex, including genetic, immune, infectious, and endocrine factors. 50%-60% of miscarriages are caused by chromosomal abnormalities. Chromosomal microarray analysis (CMA) is a key tool in this context, capable of detecting not only copy number variations (CNV) but also loss of heterozygosity (LOH). CMA has been used as a tool to investigate the genetic reasons for miscarriage.
METHODS
In our study, chromosomal microarray analysis (CMA) conducted 1220 miscarriage villous tissues. The results from this technology were used to identify the genetic reasons for miscarriage and evaluated strategies for subsequent pre-pregnancy planning.
RESULTS
Here, the abnormality rate of miscarriage was 56.07%(684/1220). The aneuploidy rate accounted for 81.14%(555/684), and was significantly higher in group >35-year-old age. The second most common genetic reason for miscarriage was polyploidy, accounting for 10.09%(69/684). Additionally, we discovered loss of heterozygosity (LOH) in a small percentage of cases, accounting for 2.20%(15/684) reason for miscarriage genetic reasons, due to the advantage of CMA can detect isodisomy (a kind of uniparental disomy). 45 cases (6.58%) with copy number variants, which due to the CMA can detect copy number variations.
CONCLUSION
Our study indicated that miscarriage villous tissues should be performed genetic analysis, seek help from professional genetic counseling.
PubMed: 38835973
DOI: 10.2147/TACG.S461674 -
Journal of Children's Orthopaedics Jun 2024The etiology and risk factors of congenital vertebral anomalies are mainly unclear in isolated cases. Also, there are no reports on the risk factors for different...
BACKGROUND
The etiology and risk factors of congenital vertebral anomalies are mainly unclear in isolated cases. Also, there are no reports on the risk factors for different subgroups of vertebral anomalies. Therefore, we assessed and identified potential maternal risk factors for these anomalies and hypothesized that diabetes, other chronic diseases, smoking, obesity, and medication in early pregnancy would increase the risk of congenital vertebral anomalies.
METHODS
All cases with congenital vertebral anomalies were identified in the Finnish Register of Congenital Malformations from 1997 to 2016 for this nationwide register-based case-control study. Five matched controls without vertebral malformations were randomly selected. Analyzed maternal risk factors included maternal age, body mass index, parity, smoking, history of miscarriages, chronic diseases, and prescription drug purchases in early pregnancy.
RESULTS
The register search identified 256 cases with congenital vertebral malformations. After excluding 66 syndromic cases, 190 non-syndromic malformations (74 formation defects, 4 segmentation defects, and 112 mixed anomalies) were included in the study. Maternal smoking was a significant risk factor for formation defects (adjusted odds ratio 2.33, 95% confidence interval 1.21-4.47). Also, pregestational diabetes (adjusted odds ratio 8.53, 95% confidence interval 2.33-31.20) and rheumatoid arthritis (adjusted odds ratio 13.19, 95% confidence interval 1.31-132.95) were associated with mixed vertebral anomalies.
CONCLUSION
Maternal pregestational diabetes and rheumatoid arthritis were associated with an increased risk of mixed vertebral anomalies. Maternal smoking increases the risk of formation defects and represents an avoidable risk factor for congenital scoliosis.
LEVEL OF EVIDENCE
III.
PubMed: 38831858
DOI: 10.1177/18632521241235027 -
International Journal of Nursing... Jun 2024Diversity in spirituality, religion, and cultural norms among women leads to varying attitudes, grieving processes, and coping mechanisms after a pregnancy loss. Despite... (Review)
Review
BACKGROUND
Diversity in spirituality, religion, and cultural norms among women leads to varying attitudes, grieving processes, and coping mechanisms after a pregnancy loss. Despite this, there is a limited understanding of grief, coping mechanisms, and mental health outcomes following pregnancy loss among Muslim women.
OBJECTIVES
This study aims to examine the impact of religion, spirituality, and faith communities on the psychological health of Muslim women during pregnancy loss.
METHOD
We systematically searched six databases with the key concepts, 'pregnancy loss' and 'Muslim women,' in PubMed, CINAHL, Embase, Web of Science, APA PsycINFO, and Academic Search. The search strategy was developed in line with the PCOT framework: Population - Muslim Women with "pregnancy loss," "miscarriage," "stillbirth, Context - "religion," faith, "spirituality," "faith communities," Outcome - "religious practices," perception, coping mechanism, "psychological health."Studies were screened, their quality appraised, and narratively sized in line with the review aim. The review protocol was registered at Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/52QTA.
RESULT
Findings from the reviewed articles addressed the following themes: (a) Overwhelming Grief and Loss, (b) social isolation and stigmatization, (c) impact on mental health, and (d) trust in divine destiny. Islamic beliefs were strongly featured in how Muslim women processed pregnancy loss. Concepts such as tawakkul and yaqeen (trusting and certainty) were used to interpret pregnancy loss, with many women acknowledging that their Islamic faith eased the sorrow of pregnancy loss, facilitated acceptance, and strengthened their Islamic belief system.
CONCLUSION
This review revealed that there is limited information on Muslim women's experience of pregnancy loss. Professionals helping Muslim women dealing with the grief of pregnancy loss need to be aware that spirituality and faith communities play a major role in shaping their coping mechanisms. Future studies on the development of culturally congruent bereavement care models and supportive interventions for Muslim women facing pregnancy loss.
PubMed: 38827821
DOI: 10.1016/j.ijnsa.2024.100205